Neuromuscular Physical Therapy Definition

Neuromuscular physical therapy is the detection, assessment, and correction of the pain and dysfunction associated with neuromuscular diseases and injuries through the application of physical therapies, exercise , activities, and assistive devices.

Purpose

The purpose of neuromuscular physical therapy is to examine, treat, and train individuals with neuromuscular diseases and injuries in order to limit their physical disability and reduce symptoms such as pain, muscle spasms and contractions, while addressing related structural and postural abnormalities. Physical therapists will work to restore fitness and health to the highest possible degree, specifically locating areas of tissue spasm and helping to release it, finding and eliminating trigger points causing pain, and helping to restore postural alignment and flexibility. The goal of physical therapy is to rebuild the strength of tissue injured by neuromuscular disease or injuries, to restore physical functioning as much as possible, and to improve the flow of blood and lymph in the body, promoting overall health. Patients who may require neuromuscular physical therapy include people who have been injured in accidents and those who are disabled by low back pain, osteoporosis, osteoarthritis, rheumatoid arthritis, fibromyalgia, sciatica , scoliosis, heart disease , Parkinson's disease, fractures, head and spinal injuries, multiple sclerosis and cerebral palsy.

Following the “Guide to Physical Therapist Practice, Part II,” published and followed by the American Physical Therapy Association, patients with neurological dysfunction are evaluated based on their medical diagnosis and the condition of the patient's nervous system functioning prior to being diagnosed with neuromuscular or neurological dysfunction. The type of physical therapy intervention will be directed by the degree of restoration possible with the given diagnosis and prior level of functioning.

Precautions

Neuromuscular physical therapy must be ordered by a physician and an accurate diagnosis must be provided to the physical therapist to enable the provision of appropriate evaluation and development of a realistic therapy plan.

Steps of recovery

An individual who has been referred for neuromuscular physical therapy will be evaluated and tested so that appropriate treatment and instruction can be provided, including physical therapy, exercise and activities, and the possible use of assistive devices for therapeutic purposes.

Specific steps to recovery include:

• The individual's medical history will be taken and physical examination will be conducted to evaluate level of impairment, including measurements of strength, range of motion, movement of separate body segments, speed of movement and ability to repeat movements, sense of joint position, vertical orientation, orientation of self within the environment, balance, coordination, posture, muscle tone and performance, respiration, motor skills and mental function. In addition, the physical therapist will evaluate the individual's ability to perform daily tasks independently. Tasks that require shifting from one posture to another will be evaluated for specific movements that present problems or where deficits in movement are noted. The therapist will also evaluate how the patient responds to verbal cues.
• A treatment plan will be designed based on the medical history and physical examination, including the purpose of treatment, treatment strategy and anticipated outcome of treatment. The overall goal of treatment is always to restore an individual's ability to function to the highest degree possible. Individual goals are typically established to address specific problems or to improve specific functions such as ability to feed or dress oneself, or to stand or walk, etc. The plan will also recommend specific ways to communicate with the individual to encourage performance of tasks.
• Individuals who are lacking in strength, flexibility and endurance may be instructed to perform exercises designed to improve strength, mobility, range of motion, balance, coordination and endurance. Exercises may be performed at a physical therapy center or at home.
• Neuromuscular physical therapy may use techniques such as electrical stimulation, hot or cold compresses, and ultrasound to help relieve pain and reduce swelling. Traction and deep tissue massage may be applied to help relieve pain. Crutches, prosteses, and wheelchairs or walkers may be recommended and the individual will be trained to use these assistive devices appropriately.
• Length of treatment will vary depending on severity of the neuromuscular disease or injury being treated and degree of progress by the individual as well as overall attitude toward physical therapy measures.

Alternative neuromuscular therapies

• Alexander technique—a technique designed to restore muscles to their natural functions; useful in treating a variety of neurological and musculoskeletal conditions, including neck, back and hip injuries or disorders, including low back pain; traumatic injuries and strain injuries; chronic pain, osteo- and rheumatoid arthritis; disorders that affect breathing and coordination; stress-related disorders; migraine headaches, chronic fatigue syndrome, lupus and fibromyalgia and Parkinson's disease.
• Aston patterning—a special physical training program combined with massage therapy that is designed to relieve muscle tension, reduce pain, speed the recovery from injuries, encourage relaxation and reduce stress. Back and neck pain, headache and injuries from repetitive stress (carpal tunnel syndrome and tennis elbow) respond well to Aston patterning.
• Feldenkrais method—a supportive therapy that is useful when individual movement patterns and postural traits can be improved to help recover from neuromuscular disease or injury; it is especially useful for chronic pain, multiple sclerosis, cerebral palsy, and disability following stroke.
• Hellerwork—a combination of deep tissue massage and movement training for problems related to muscle tension and stress-related injury.
• Trager massage—a gentle form of massage therapy that releases deeply ingrained tension and promotes relaxation. It may be applied successfully to treat stress-related pain or injury, high blood pressure, stroke, migraine headaches and asthma as well as multiple sclerosis and muscular dystrophy.

Challenges

Many patients with neuromuscular disease or injury are simultaneously struggling with the underlying disease or injury and have little energy to give to therapeutic measures. The greatest challenge patients may face is the ability to follow instructions and willingness to regularly perform recommended exercises or treatments. Physical therapy works when the individual is willing to work consistently. Regular instruction and practice is essential in order to see progress.

KEY TERMS

Lymph —Clear fluid in body tissues that is produced by the lymph nodes and flows through lymphatic vessels into the bloodstream. It is an important part of the body's immune system.

Lymphatic —Pertaining to lymph or the lymphatic vessels that contain lymph.

Neuromuscular —Refers to the relationship between nerves and muscles. Neuromuscular disorders or injuries involve both nerves and muscles.

Structural alignment —Refers to the normal longitudinal formation of the individual bones and muscles of the body such as limbs, as well as the formation and structural support of the whole skeleton.

Risks

Severe muscle tone dysfunction and lack of movement early in the course of recovery indicates poor potential for improved motor recovery. The risk of further injury and dysfunction is greatest when the physical therapy plan can not be followed consistently by the patient or response to treatment for the underlying diagnosis is poor. Diseases that affect neuromuscular functioning have various degrees of potential for recovery and various timing is involved. Stroke patients, for example, who do not see improvement in motor skills, grip strength or other signs of functional status within 24 days to three months may have limited potential for recovering motor function. Depending on the degree of injury or disease, continued muscle spasm with no relief and no exercise may result in eventual muscle atrophy, compromising flexibility and mobility. Restrictions in blood flow and the flow of lymphatic fluid can interfere with organ function, resulting in eventual organ failure.

Results

The optimal result of neuromuscular physical therapy is that the performance of mobility tasks utilizes all essential movement components of the specific task, since treatment strategies are designed to improve tese essential movement components. The best result for the patient is therefore when normal alignment, muscle performance and movement patterns have been restored, leading to improved functioning in daily life and improved general health. Therapists may also help a patient who has not responded to normal movement strategies compensate for movement dysfunction by altering alignment, muscle performance and movement patterns and thereby offsetting the effect of the underlying dysfunction. This compensatory movement may allow an individual to function more independently even though normal movement strategies did not work as intended.

Resources

BOOK

Guide to Physical Therapist Practice, Part II 2nd Ed. American Physical Therapy Association, 2001.

PERIODICALS

Sheets PK. “Diagnosis for physical therapy for patients with neuromuscular conditions.” Neurology Report, Oct. 1999.

WEBSITES

“Neuromuscular Physical Therapy.” Encyclopedia of Nursing & Allied Health, 2002. Available at www.enotes.com/nursing-encyclopedia/neuromuscular-physical-therapy/. Accessed March 11, 2008.

ORGANIZATIONS

American Physical Therapy Association, 1111 North Fairfax Street, Alexandria, VA, 22314-1488, www.apta.org.

L. Lee Culvert